Pioneer ACO 3-Day SNF Waiver: CMS Offers Another Chance in a Shared Savings Model

Abstract Nearly 50 years ago, Medicare created a 3-day inpatient hospitalization requirement for the Medicare Part A eligibility of the post-acute care Skilled Nursing Facility (SNF) Benefit. The practice of Medicine in 1965 when the SNF benefit was created was completely different than care in today’s world. Multiple attempts at waiving this 3-day requirement have come and gone with variable and sometimes poor results. The original intent of the Health Care Financing Administrations’ (HCFA) 3-day requirement was to ensure appropriate utilization of resources for patients who truly needed skilled care in the post-hospitalization period. Inpatient hospitalizations in 1965 of greater than 3 days were the norm for a multitude of diagnoses that are now routinely cared for with less than 3-day inpatient hospitalizations and often even as an outpatient. Thus, with modernization of medicine, an increasing cohort of patients requiring SNF level of care are precluded from receiving this Medicare benefit due to inability to qualify for lack of a 3-day inpatient hospitalization. The Centers for Medicare and Medicaid Services (CMS) approved a new 3-day waiver for Pioneer Accountable Care Organizations in April 2014. Presumably, in an arena of capitated payments, this will incentivize clinicians to send patients to the appropriate level of care based upon clinical assessment, thus avoiding costly and unnecessary hospitalizations.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research